by Tracy and Mike Davenport
Review by Joanne Matthews
It contains some excellent chapters in Part 3 of the book called “Discussions from Experts in the Field”.
It contains chapters on:
- “Patients without words” with specific reference to infants who can’t communicate with words written. This chapter is very short but interesting because it’s written by an equine vet (!) who talks about how you care for patients who literally can’t speak (i.e. animals) as a comparison to infants, i.e. observe and record, planning treatment, advocacy etc. It’s aimed at parents and is surprisingly useful;
- “Caring for the chronically ill” written by a behavioral psychologist and focused on providing advice to parents on how to cope with managing a chronically ill child. Also very good. It introduces parents to the idea that caring for one of these children is an endurance event and it’s important to pace yourself to get through it. Sobering but very helpful advice.
- “Nutrition for the child with acid reflux” by a dietician. Brief but a useful chapter. There is probably more information contained in some of the other reflux books on this subject.
- “Extra-oesophageal reflux and symptoms of the ear, nose and throat” is another truly excellent chapter. Co-authored by the same pharmacologist as for the chapter on medication (13) and a senior paediatric ENT, it is outstanding and the illustrations are also excellent in helping to understand the link between the two types of conditions. “Extra-Esophageal” = silent reflux.
- “The use of medications in acid-reflux disease” by a leading pharmacologist. I found this chapter compelling and have focused the remainder of the review on this chapter.
Of particular interest to me was Chapter 13 “Use of Medication in Acid-Reflux Disease” by Assoc Prof Jeff Phillips PharmD*, Head of Applied Research, Dept of Surgery, University of Missouri and Stacy Turpin, MS, a medical illustrator with the same department.
A number of books describe the way that various acid reflux medications work. I found this one best to understand how they work in children. Specifically, he describes the limitations of H-2 blockers (like Zantac) in children.
“One of the problems with these drugs in children is that children develop tolerance (very rapidly) to the effects of all H-2 blockers. This can happen in as little as one week.” pg 204
I found this explained my experience with this class of drug with my child. And it also explains why it might be effective in some and not others.
His description of the way in which Proton Pump Inhibitors (PPIs) work was very informative. He claims PPIs are the preferred treatment for acid reflux in children. I know I would be interested in studies that showed the efficacy of these two classes of drug used in combination.
“PPIs are highly effective with a very wide safety margin.” pg 206
“PPIs are safer and more effective than H-2 blocker drugs.” pg 208
“The main problem [with PPIs] is that they are often under-dosed in children… [they] metabolize PPI drugs about three times faster than adults and as such they require the drug to be given about three times per day to make up for the rapid elimination.” pg 207
He goes on to argue that both the dosage and the frequency of PPIs should be higher in children than adults. Dosage guides are also provided.
While RISA does not publish dosage charts, it does seem to be the case that this dosing and frequency information is not well known in Australia and that having a copy of this book when going to see your medical professionals might help both you and your doctor arrive at the most appropriate medical therapy for your child. It remains extremely important that decisions regarding dosage and frequency be made by your medical professional.
Acid Reflux in Infants and Children by Tracy and Mike Davenport is available to RISA members to borrow from the RISA Library.
* Dr. Phillips is known for his invention combining a buffer with a non-enteric coated proton pump inhibitor, or PPI, (a class of drugs that prevent the production of excess stomach acid). His invention defied the conventional wisdom of the time that an enteric coating was essential to protecting the drug from the acid environment of the stomach. Dr. Phillips continues to develop a portfolio of inventions related to the PPIs, including novel combinations and new uses of the drugs. He was the first to develop a method of using a tiny, radio frequency pH probe in young children that is much more tolerable than traditional means of diagnosis. He also developed a software program that creates more meaningful diagnostic data for acid reflux disease.